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Cochlear implantation through the round window with a straight slotted electrode array: optimizing the surgical

Thierry Mom1,2, Aurélie Bachy3, Aubry Houette3

  • 1Department of Otolaryngology Head and Neck Surgery, University Hospital Center CHU Gabriel Montpied, Université d'Auvergne Clermont 1, 30 place Henri Dunant, 63000, Clermont-Ferrand, France. tmom@chu-clermontferrand.fr.

European Archives of Oto-Rhino-Laryngology : Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : Affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery
|April 21, 2015
PubMed
Summary

Optimizing cochlear implant insertion through the round window using a straight, slotted electrode array with a soft tip achieves 94% full insertion. Drilling prominent crista fenestrae is recommended for better outcomes.

Keywords:
Cochlear implantElectrode arrayInsertionRound window anatomy

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Area of Science:

  • Otolaryngology
  • Neurosurgery
  • Biomedical Engineering

Background:

  • Cochlear implantation aims to restore hearing in individuals with severe to profound sensorineural hearing loss.
  • The round window is a common insertion site for cochlear implant electrode arrays.
  • Electrode array design and insertion technique influence surgical outcomes and hearing restoration efficacy.

Purpose of the Study:

  • To evaluate the efficacy of optimizing insertion quality through the round window using a straight and slotted electrode array.
  • To assess the impact of electrode tip design on insertion success and associated morbidities.
  • To determine the optimal surgical approach for cochlear implant placement via the round window.

Main Methods:

  • Retrospective analysis of 126 cochlear implantations using the Digisonic SP (Neurelec-Oticon Medical) system since 2004.
  • Review of operative charts, insertion depth, and follow-up data.
  • Comparison of insertion success rates between straight electrode arrays with square versus soft pointed tips using Chi-square tests.

Main Results:

  • Full insertion was achieved in 94% of cases when using a straight and slotted electrode array with a soft tip.
  • Electrode arrays with soft tips demonstrated significantly higher full insertion rates (79/84) compared to square tips (18/42) (p < 0.0001).
  • Two cases experienced difficulty due to a prominent crista fenestrae; the chorda tympani nerve was preserved in all but one case.

Conclusions:

  • Round window implantation with a straight, slotted electrode array and a soft tip is highly effective, achieving 94% full insertion.
  • The soft tip design significantly improves the likelihood of complete electrode array insertion.
  • Addressing prominent crista fenestrae by drilling is recommended to prevent insertion difficulties.